Avoiding superior tilt in reverse shoulder arthroplasty: a review of the literature and technical recommendations

Laver, Lior; Garrigues, Grant E.

doi:10.1016/j.jse.2014.06.029

Cited by 85 publications

(51 citation statements)

References 53 publications

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“…13,16,19,25,29,36 Superior inclination of the baseplate increases the stresses at the implantbone interface while leading to impingement between the inferior humeral polyethylene insert and scapula pillar, 13 causing medial polyethylene wear, scapular notching, and eventual glenoid implant loosening. 16,19,25,29,36 In addition, superior inclination of the baseplate has been shown to be associated with decreased shoulder range of motion. 23,24 Although there is much debate about the best way to correct this superior glenoid inclination, it is critical to implant the baseplate in at least neutral inclination.…”

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confidence: 99%

“…23,24 Although there is much debate about the best way to correct this superior glenoid inclination, it is critical to implant the baseplate in at least neutral inclination. 11,12,25 The optimal position of the reverse baseplate is inferior on the glenoid and without superior tilt, in an attempt to optimize impingement-free range of motion while avoiding scapular notching and glenoid loosening. 5,6,13,26,31,32,35 Glenoid inclination, as described by Hughes et al 20 and Maurer et al, 27 is commonly thought to be the angle between the floor of the supraspinatus fossa and the glenoid fossa line: the b angle.…”

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confidence: 99%

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The reverse shoulder arthroplasty angle: a new measurement of glenoid inclination for reverse shoulder arthroplasty

Boileau¹,

Gauci²,

Wagner

et al. 2019

Journal of Shoulder and Elbow Surgery

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Background: Avoiding superior inclination of the glenoid component in reverse shoulder arthroplasty (RSA) is crucial. We hypothesized that superior inclination was underestimated in RSA. Our purpose was to describe and assess a new measurement of inclination for the inferior portion of the glenoid (where the baseplate rests). Methods: The study included 47 shoulders with rotator cuff tear arthropathy (mean age, 76 years). The reverse shoulder arthroplasty angle (RSA angle), defined as the angle between the inferior part of the glenoid fossa and the perpendicular to the floor of the supraspinatus, was compared with the global glenoid inclination (b angle or total shoulder arthroplasty [TSA] angle). Measurements were made on plain anteroposterior radiographs and reformatted 2dimensional (2D) computed tomography (CT) scans by 3 independent observers and compared with 3-dimensional (3D) software (Glenosys) measurements. Results: The mean RSA angle was 25 AE 8 on plain radiographs, 20 AE 6 on reformatted 2D CT scans, and 21 AE 5 via 3D reconstruction software. The mean TSA angle was on average 10 AE 5 lower than the mean RSA angle (P < .001); this difference was observed regardless of the method of measurement (radiographs, 2D CT, or 3D CT) and type of glenoid erosion according to Favard. In Favard type E1 glenoids with central concentric erosion, the difference between the 2 angles was 12 AE 4 (P < .001). Conclusion: The same angle cannot be used to measure glenoid inclination in anatomic and reverse prostheses. The TSA (or b) angle underestimates the superior orientation of the reverse baseplate in RSA. The RSA angle (20 AE 5) needs to be corrected to achieve neutral inclination of the baseplate (RSA angle ¼ 0). Surgeons should be aware that E1 glenoids (with central erosion) are at risk for baseplate superior tilt if the RSA angle is not corrected.

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confidence: 99%

mentioning

confidence: 99%

The reverse shoulder arthroplasty angle: a new measurement of glenoid inclination for reverse shoulder arthroplasty

Boileau¹,

Gauci²,

Wagner

et al. 2019

Journal of Shoulder and Elbow Surgery

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“…However, unsolved questions and controversy with regard to implant placement and design remain. Although the literature is clear that superior baseplate positioning and tilt are undesirable and should be avoided 14,23,24 , no concrete conclusion with regard to medialization or lateralization of the glenosphere, neutral or slightly inferior baseplate tilt, and humerosocket inclination can be made. Further research is necessary to determine optimal implant positioning and design in reverse total shoulder arthroplasty.…”

Section: Resultsmentioning

confidence: 99%

“…In another cadaveric study, this caudal placement increased internal rotation, external rotation, abduction, and adduction while reducing notching 22 . Because of difficulties with exposure or superior glenoid erosion, some early implants were placed with the baseplate tilted superiorly 23 . A validated computer model was used to show that this position leads to an uneven force distribution with increased shear and tensile forces 24 14,23,24 .…”

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confidence: 99%

Current Controversies in Reverse Total Shoulder Arthroplasty

Churchill

Garrigues

2016

JBJS Rev

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Reverse total shoulder arthroplasty can restore forward elevation in pseudoparalytic shoulders, can reduce pain, and can increase quality of life for patients; however, there are a number of issues with regard to the design and ideal implantation technique of reverse total shoulder arthroplasties that remain controversial. Glenospheres with a Grammont, medialized center of rotation and designs with a more lateralized center of rotation have specific pros and cons. Medialized designs have historically decreased glenosphere loosening but increase scapular notching, and lateralized designs decrease notching and improve range of motion but historically have resulted in increased baseplate failure. As such, a concrete conclusion with regard to medialization or lateralization of the glenosphere cannot be made at this time. Caudal, inferior placement of the glenosphere increases internal rotation, external rotation, abduction, and adduction while reducing notching. Superior baseplate positioning and tilt are correlated with baseplate failure and therefore should be avoided. It remains unclear whether neutral or slightly inferior tilt is preferred. The ideal humerosocket inclination angle remains unclear. The 135[degrees] designs appear to have a lower rate of scapular notching than the Grammont-style 155[degrees] humerosockets. The implications of this angle for instability remain unclear as, to our knowledge, there have been no randomized comparisons and the largest meta-analysis was confounded by other implant variables.

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“…In caso di lussazione può essere presente una frattura della glena: tale condizione solo raramente richiede l'esecuzione di un innesto osseo per garantire una buona interfaccia tra la metaglena e l'osso, aspetto di primaria importanza per un corretto posizionamento della componente e per la sua fissazione. Come è noto, è necessario evitare un posizionamento troppo alto della metaglena così come un suo tilt superiore: tali condizioni aumentano il rischio di notching scapolare evolutivo e di mobilizzazione a breve termine [25,26]. Una volta completato il tempo scapolare con l'assemblaggio della glenosfera, si procede all'impianto della componente omerale.…”

Section: Protesi Totale Inversaunclassified

Protesi di spalla in acuto

Grassi

2015

LO SCALPELLO

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SHOULDER REPLACEMENT FOR ACUTE FRACTURESShoulder replacement for proximal humeral fractures can be performed with two different prostheses: anatomical hemiarthroplasty and reverse total arthroplasty. A careful evaluation of the fracture pattern and the patient, in addition to a rigorous operative technique, are the prerequisites for optimizing the clinical-functional outcome.Pubblicato online: 9 settembre 2015 © Springer-Verlag Italia 2015Le fratture dell'omero prossimale comprendono un ampio spettro di lesioni, il cui trattamento prevede un algoritmo complesso e spesso controverso. La scelta della migliore opzione terapeutica non deve basarsi in modo esclusivo sugli aspetti anatomo-patologici locali, talvolta di difficile definizione, ma richiede altresì un'attenta valutazione del paziente in termini di condizioni generali, richieste funzionali e compliance al percorso riabilitativo. La sostituzione protesica della spalla fu introdotta da Charles Neer negli anni Cinquanta proprio per il trattamento chirurgico delle fratture più complesse dell'omero prossimale, laddove le metodiche disponibili non consentivano di ottenere risultati clinico-funzionali accettabili [1]. In base alla classificazione dello stesso autore, queste lesioni comprendevano le fratture a 4 parti, diverse fratture a 3 parti, le fratture-lussazioni pluriframmentarie e quelle con un'estesa compromissione della superficie articolare. Dopo un periodo iniziale di entusiasmo e progressiva diffusione delle tecniche di protesizzazione della spalla, adottate con successo anche nel campo della patologia degenerativoinfiammatoria, si è giunti alla consapevolezza che i risultati in campo traumatologico erano molto variabili, poco riproducibili e spesso insoddisfacenti [2][3][4]. Questa rivalutazione critica, associata a un miglioramento delle tecniche di osteosintesi, ha determinato un importante ridimensionamento del ruolo delle protesi anatomiche nel trattamento delle fratture. L'impiego in campo traumatologico della protesi inversa, ideata da Paul Grammont alla fine degli anni Ottanta per trattare le spalle pseudoparalitiche da compromissione della cuffia, ha migliorato le prospettive prognostiche nella protesizzazione per frattura, soprattutto per i pazienti di età più avanzata [5,6]. Per questo motivo, si assiste oggi a un ritrovato impulso verso la sostituzione protesica per le fratture complesse dell'omero prossimale, al punto che appare doveroso precisarne le corrette indicazioni, i limiti e le possibili complicanze, per evitare di cadere in un eccessivo e ingiustificato ricorso al loro impiego. Protesi parziale anatomicaLa protesizzazione anatomica per fratture dell'omero prossimale prevede l'impianto della sola componente omerale. Più che di endoprotesi di spalla-termine che potrebbe erroneamente far pensare ad analogie con il femore prossimalesarebbe più preciso parlare di un intervento di "osteosintesi aumentata", poiché il momento fondamentale della procedura è la ricostruzione, quanto più stabile e anatomica possibile, delle tuberosità intor...

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Avoiding superior tilt in reverse shoulder arthroplasty: a review of the literature and technical recommendations

Cited by 85 publications

References 53 publications

The reverse shoulder arthroplasty angle: a new measurement of glenoid inclination for reverse shoulder arthroplasty

The reverse shoulder arthroplasty angle: a new measurement of glenoid inclination for reverse shoulder arthroplasty

Current Controversies in Reverse Total Shoulder Arthroplasty

Protesi di spalla in acuto

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